Purpose It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different surgical approach, a modified canal wall-down procedure, to completely clear the disease but fully preserve the tympanum. We present one such exceptional case. Case presentation A 28-year-old lady presented with ear discharge for 1 year. Imaging confirmed the canal-mastoid fistula, but the entire tympanum was normal. We performed a modified-modified radical mastoidectomy. Conclusions Canal-mastoid fistula is an infrequent entity and may be idiopathic. Despite being evident on clinical examination, imaging aids in assessing size and location of the defect. Although EAC reconstruction may be attempted, the majority require a canal wall-down procedure.
Actinomycosis is caused by actinomyces israelii, a gram positive nonacid fast, anaerobic, commensal bacterium within the oral cavity. Though it is a commensal in oral cavity, it seldom presents as cervicofacial actinomycosis. But there is limited access to literature proving cervicofacial actinomycosis existence so far. We report a case of 35 year old gentleman who presented with painless progressive neck swelling associated with pain while chewing food. On examination, 3.5*2.5 swelling was noted in right submandibular gland area, radiologically a foreign body was detected in the right submandibular gland. Mass was excised in toto and sent for HPE which revealed submandibular gland actinomycosis. Post operatively, patient was managed with long-term broad-spectrum beta lactams and was on regular follow-up. No evidence of recurrence/ fresh complaints noted till date. Although cervicofacial actinomycosis is rare and dangerous with debilitating complications, timely diagnosis and early intervention with broad spectrum antibiotics and surgical excision (if required) shows promising results with complete eradication of disease leaving no residues.
Introduction: Oronasopharyngeal stricture is a rare sequel of oropharyngeal surgical procedure which can cause swallowing difficulty, dyspnea, sleep related breathing disorders, incompetence at the velopharynx due to soft palatal adherence. Case: Here we present a case of nine-year-old girl who presented to us with complains of nasal obstruction since 3 months and symptoms of sleep disordered breathing. She underwent adenotonsillectomy 5 years ago and coblator assisted palatoplasty and stricture release 4 months ago. On examination adenoid facies was noted, postpalatoplasty and tonsillectomy status with stricture between the anterior and posterior tonsillar pillars. Soft palate was stuck to posterior pharyngeal wall. Computed tomography scan was done which depicted homogenously enhancing soft tissue density causing complete nasopharyngeal airway obstruction. Oronasopharyngeal stricture release was performed under general anesthesia. Infant feeding tube was inserted through the nasal cavity and introduced through the oropharynx into exterior and was tied externally which was removed on postoperative day 5. Child is on regular follow up since 5 months and asymptomatic. Discussion: Oropharyngeal stricture is reported as a rare sequela of adenotonsillectomy. Many surgical techniques have been reported for release of similar oropharyngeal and nasopharyngeal stricture patterns such as triamcinolone injection, manual dilation method, plasma hook method, division and skin grafting, local flaps like pharyngeal or palatal mucosal flaps, and free flap techniques. Conclusion: Utmost care must be taken during the surgical procedure of oropharynx to prevent collateral damage to mucosal surfaces which can result in such devastating complications.
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